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回應財政預算案

在最新一份財政預算案中，政府將在2018/19年度增加對醫院管理局（醫管局）的經常資助近60億元，並預留3,000億元作第二個十年醫院發展計劃之用，當中包括多間醫院的重建或擴建，以及增加醫療教學設施，亦將繼續增加醫生及其他醫療人員的資助學額，同時確保醫管局有足夠資源聘請所有本地醫科畢業生。十五年前政府縮減醫管局資源，令當年醫科畢業生喪失訓練機會、資深公立醫院醫生前途黯淡，士氣低落，埋下醫生離職潮的伏筆，多年下來，令公立醫院人手不足，前車可鑑、歷歷在目。今天政府算是吸取教訓，勇於承擔、積極有為。上述撥款有助提升醫療服務質素，香港醫學會對此表示歡迎和支持。

財政司司長近日在電台節目中回應有關醫管局人手短缺的問題時，未有針對癥結探討醫管局未能挽留人才、減少外流的嚴重缺失，以為只要引入境外醫生，難題自會迎刃而解。更甚者把難題歸咎於所謂「保護主義」，指責醫學界2016年反對立法會通過《醫生註冊（修訂）條例草案》。 當年政府一再指修訂條例非為輸入境外醫生，而為增加醫委會內公眾參與，言猶在耳，如今卻說條例修訂是為了方便引入境外醫生，其辭矛盾，令人費解。

就財政司司長的言論，本會認為須要釐清一些事實和觀點。

首先，我們感謝公立醫院的醫生同業在緊張的資源下克盡己責，為市民提供高質素的醫療服務。 現時全港的專科醫生當中，約有3,000-4,000 名（約四成半）在公立醫院服務，照顧全港近九成的住院病人，而其餘約五成半的私人執業專科醫生則僅照顧全港一成的私家醫院病人。 公、私營醫生對病人的比例分別是0.9:1000 和 4.5:1000，落差巨大。因此我們認為吸引醫生回流公院，或透過協作計劃善用私人醫生人力資源，要比引入境外醫生更能迅速解決問題。

醫管局由2012年至2017年底共聘請了34名經有限度註冊來港的境外醫生，截至2017年底，只有12名在任。同期，醫務委員會只否決了一份申請，原因是經驗不符所需，「保護主義」之說不攻自破。醫管局既不能挽留本地畢業醫生，亦無法留住境外醫生，歸根究底，這才是人才流失、人手不足的主因。2016年《草案》之中有關有限度註冊年期從一年改為三年的修訂，也一直得到本會全面和公開的支持。

針對公立醫院醫生流失的問題，本會於2014底年向醫委會建議，給予所有通過《醫務委員會執業資格試》的考生三年的醫管局工作合約，作為縮短實習期6個月的條件，可惜建議遭到否決。

有評論指醫學界基於「保護主義」，將《執業資格試》的合格門檻拉高，故意將境外醫生拒於門外。《執業資格試》的合格標準由香港兩間大學醫學院釐定，聽說程度等同本地醫科生的畢業試。本會以及廣大醫生根本不涉釐定考試標準，更無從舞高弄低，如有懷疑，敬請向醫學院查詢。

本會不反對香港參考國內以致海外一些國家設立《統一執業資格試》， 醫學畢業生不分本地或境外，均須通過統一考試獲取醫生執業資格以確保公平。惟改變巨大，未有充份準備不宜輕率，亦不宜影響在學醫科生。

本會樂見醫務委員會近年推出多項舉措，便利境外醫生報考《執業資格試》，包括增加每年考試場次及豁免許可。總括而言，我們歡迎合乎標準的境外醫生來港執業，包括通過考試，亦包括醫管局透過「有限度註冊」聘請更多境外畢業的港人或精英在公立醫院服務市民。

醫生的「保護主義」是保護市民主義，任何人不應高叫口號以掩飾施政失誤，諉過於人。對立、針對性的言論無從解決問題，只會進一步扼殺對話和合作的空間。

二零一八年三月十二日

編輯備忘：

香港醫學會成立於一九二零年，旨在聯繫政府、各公立醫療機構、大學及私人執業的醫務工作者，交流意見，團結一心。醫學會致力將最新的醫療資訊及醫務發展傳遞與會員，提倡會員遵行專業操守，進而服務社會，維護民康。

PRESS

RELEASE

12 March 2018

Response to Budget 2018

The 2018-19 Budget witnesses the Government delivering bountiful measures to improve the healthcare services of Hong Kong.  We saw an additional recurrent funding of around $6 billion injected into the Hospital Authority (HA), a $300 billion earmarked for the second 10-year hospital development plan whereby public hospitals will undergo redevelopment, expansion and a new hospital built.   Funds will be allocated to improve healthcare teaching facilities and further increase publicly funded training places for healthcare professionals.  The profession is glad to be reassured of adequate resources for HA to employ all local medical graduates.  Ill effects of the budget cut culminating in unemployment of fresh medical graduates and dim career prospect for the trained doctors some 15 years ago still loom high, which has unwittingly precipitated the unstoppable exodus of doctors in the years that followed.  Learning a lesson from past blunder, the Government is acting all the more engaging and dutiful.  The Hong Kong Medical Association (HKMA) welcomes such moves.

The Financial Secretary recently responded to questions on manpower shortage in HA on a radio program. Unfortunately missing the crux of the matter, which is a failing system unable to retain manpower, focus was instead diverted to importing foreign doctors as though an influx from abroad would fix our problems.   What went further off the mark was an entirely unwarranted accusation of the Medical profession for “Protectionism”, and the alleged pursuit of which led to the 2016 obstruction of the Medical Registration (Amendment) Bill. Back then we heard the Government saying that the amendment was meant for increased public participation in the Medical Council rather than importing manpower.  A 2018 twist depicting the aborted Amendment as an effort to import foreign doctors was dimly amusing.

To be amusing is one thing, but let’s get the facts straight.

First and foremost, we express our deepest gratitude to Colleagues in public hospitals who worked hard and loyal to provide world class medical services to the public, despite thin resources. There are between 3,000 – 4,000 Specialists (accounting for about 45% of all Specialists in Hong Kong) working in public hospitals, serving nearly 90% of inpatients, while the remaining 55% are private Specialists who take care of roughly 10% inpatients. Roughly the same number of Specialists in public hospitals take care of 9 times their counterparts in private practice.  One can compute the wide gap of doctors to patients ratio between the public and private sector, which is 0.9:1000 and 4.5:1000 respectively.  We see it a faster way to improve public manpower shortage by attracting doctors to either rejoin public hospitals or an enhanced public-private partnership, rather than by importing foreign doctors.

From 2012-2017, HA has employed 34 foreign doctors via limited registration, with 12 remaining in office as at the end of 2017. Of all the applications, the Medical Council of Hong Kong (MCHK) has rejected 1 due to unsuitable training profile.  “Protectionism” is but slogan.  In a nutshell, HA has proved incapable of retaining doctors, be they local graduates or foreign doctors.  The end-result is the chronic manpower insufficiency haunting our public hospitals year after years.  One might recall that among other things, the 2016 “Amendment” proposed to extend the upper limit of limited registration from 1 year to 3, which is a move HKMA have all along supported unreservedly.

As a measure to curb efflux from HA, HKMA proposed to MCHK in late 2014 that candidates who have passed the Licensing Examination of the MCHK can have their 12-month internship shortened to 6 months on the condition that they work for the HA for 3 years under limited registration.  Our proposal was rejected.

Critics accused the Medical profession of setting a high pass mark for the Licensing Examination so as to effectively debar foreign doctors from practicing in Hong Kong.  “Protectionism”, they bellowed.  Strange, if one only knows that HKMA or any ordinary doctor does not have the authority to set standard for the Licensing Examination, let along pushing up the pass mark.  Setting a pass mark is in the sole authority of the two Medical faculties, which have all along maintained the standard to be in par with the final examination for their own graduates.  If in doubt, ask the universities.

HKMA does not object to a universal licensing examination whereby all wishing to practice Medicine in Hong Kong must sit, be they local graduates or foreign doctors.  This is already in common practice in Mainland China and various countries overseas.  A change that major must not be taken lightly and current medical students should not be affected.

MCHK has taken a number of initiatives in recent years to facilitate candidates to take the Licensing Examination, such as increasing the number of sittings per year and allowing exemptions.  All in all, we welcome more foreign doctors, either proven capable by examination or in employment by HA via limited registrations to serve the public. 

Our “Protectionism” if you like, is an ideology of protecting our patients.  We see no merit in sloganizing in order to cover up one’s administrative insufficiency and laying blame on others.  Antagonism goes nowhere near solving any problem, and will only hamper useful communication and cooperation.

Notes to editors:

The Hong Kong Medical Association, founded in 1920, aims to bring together Hong Kong's government, institutional, university and private medical practitioners for an effective exchange of views and co-ordination of efforts.  The foremost objective of the Association is to safeguard and promote public health.  The Association speaks collectively for its members and aims to keep its members abreast of medical ethics, issues and advances around the world.  In fulfilling these goals, the association hopes to better serve the people of Hong Kong.